Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur / A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion

Introducción y objetivos: La medición precisa de la torsión femoral es esencial para el diagnóstico, indicación y planificación preoperatoria de las osteotomías desrotadoras femorales en pacientes con inestabilidad patelofemoral o dolor anterior de rodilla. Se han descrito múltiples métodos de medición, con valores muy diferentes entre ellos y ninguno de ellos permite establecer la magnitud de la osteotomía necesaria para devolver la torsión a valores normales. El objetivo del presente trabajo es desarrollar un método de medición que permita no solo el diagnóstico de pacientes con alteraciones torsionales, sino también establecer la magnitud de la osteotomía necesaria durante la cirugía. Material y métodos: Se seleccionaron 30 pacientes sin antecedentes de patología patelofemoral que disponían de una tomografía completa de miembros inferiores por otros motivos, siendo considerados así pacientes normales. Se calculó su torsión femoral mediante los métodos de Jeanmart y de Murphy por dos radiólogos independientes. Por otra parte, dos cirujanos ortopédicos independientes realizaron la medición de la torsión mediante el método 3D propuesto. Se evaluó el comportamiento normal de los datos y se definió la variabilidad intra- e interobservador del método 3D mediante su coeficiente de correlación intraclase y mediante el gráfico de Bland-Altman, realizando una comparación cuantitativa y cualitativa respectivamente con los métodos clásicos. Se estableció el intervalo de confianza de los valores normales con el nuevo método 3D y finalmente, se analizó al patrón de regresión lineal entre los métodos de Jeanmart y Murphy con el método de medición 3D. Resultados: La media de torsión femoral con el método 3D fue de 12,74° (DE 5,96°, IC 95%: 11,67 a 13,82°). Con el método de Jeanmart, esta fue de 12,84° (DE 8,60°, IC 95%: 11,28 a 14,39°) y de 15,87° (DE 10,68°, IC 95%: 13,94 a 17,80°) con el método de Murphy.(AU)

Introduction and objectives: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. Material and methods: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland–Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. Results: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high.(AU)

[Translated article] A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion / Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur

Introducción y objetivos: La medición precisa de la torsión femoral es esencial para el diagnóstico, indicación y planificación preoperatoria de las osteotomías desrotadoras femorales en pacientes con inestabilidad patelofemoral o dolor anterior de rodilla. Se han descrito múltiples métodos de medición, con valores muy diferentes entre ellos y ninguno de ellos permite establecer la magnitud de la osteotomía necesaria para devolver la torsión a valores normales. El objetivo del presente trabajo es desarrollar un método de medición que permita no solo el diagnóstico de pacientes con alteraciones torsionales, sino también establecer la magnitud de la osteotomía necesaria durante la cirugía. Material y métodos: Se seleccionaron 30 pacientes sin antecedentes de patología patelofemoral que disponían de una tomografía completa de miembros inferiores por otros motivos, siendo considerados así pacientes normales. Se calculó su torsión femoral mediante los métodos de Jeanmart y de Murphy por dos radiólogos independientes. Por otra parte, dos cirujanos ortopédicos independientes realizaron la medición de la torsión mediante el método 3D propuesto. Se evaluó el comportamiento normal de los datos y se definió la variabilidad intra- e interobservador del método 3D mediante su coeficiente de correlación intraclase y mediante el gráfico de Bland-Altman, realizando una comparación cuantitativa y cualitativa respectivamente con los métodos clásicos. Se estableció el intervalo de confianza de los valores normales con el nuevo método 3D y finalmente, se analizó al patrón de regresión lineal entre los métodos de Jeanmart y Murphy con el método de medición 3D. Resultados: La media de torsión femoral con el método 3D fue de 12,74° (DE 5,96°, IC 95%: 11,67 a 13,82°). Con el método de Jeanmart, esta fue de 12,84° (DE 8,60°, IC 95%: 11,28 a 14,39°) y de 15,87° (DE 10,68°, IC 95%: 13,94 a 17,80°) con el método de Murphy.(AU)

Introduction and objectives: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. Material and methods: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland–Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. Results: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high.(AU)

[Translated article] A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion.

INTRODUCTION AND OBJECTIVES: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. MATERIAL AND METHODS: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland-Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. RESULTS: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67°-13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28°-14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94°-17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high. CONCLUSION: The method presented in this study allows for the reliable quantification of femoral torsion in a reproducible way. This method can be applied in several open access 3D image programmes what makes its implementation in the healthcare centres possible from now on.

A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion. / Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur.

INTRODUCTION AND OBJECTIVES: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. MATERIAL AND METHODS: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland-Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. RESULTS: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high. CONCLUSION: The method presented in this study allows for the reliable quantification of femoral torsion in a reproducible way. This method can be applied in several open access 3D image programs what makes its implementation in the healthcare centers possible from now on.

Quiste óseo aneurismático en el sacro: caso clínico y revisión de la literatura / Aneurysmal bone cyst in the sacrum: Case report and literature review

Los quistes óseos aneurismáticos son lesiones óseas benignas infrecuentes, de localización inusual en el sacro. Sintomatológicamente son inespecíficas. Tras un traumatismo aparece dolor, pudiendo acompañarse de complicaciones de estructuras adyacentes por edema asociado. Los hallazgos de las imágenes suelen ser característicos, aunque el diagnóstico debe confirmarse por biopsia y realizar diagnóstico diferencial con otros tumores. El tratamiento a aplicar en huesos largos consiste en legrado y relleno con material de reemplazo óseo. En el sacro pueden conllevar complicaciones neurológicas, siendo la embolización arterial selectiva una alternativa en su manejo. Describimos un caso de quistes óseos aneurismáticos en el sacro en un varón de 71 años con antecedente de leucemia linfoide crónica e hiperplasia benigna de próstata. El informe incluye la presentación clínica, los hallazgos de imagen y la evolución tras el tratamiento mediante embolización arterial selectiva. Este caso destaca las opciones terapéuticas y las dificultades encontradas en el manejo de estas lesiones en el sacro que complican su tratamiento habitual. La embolización arterial selectiva es una opción terapéutica en pacientes con quistes óseos aneurismáticos en el sacro, permitiendo tratamientos menos agresivos y prósperos resultados (AU)

Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results (AU)

Plastia de rotación en escolar por osteosarcoma: Protetización y actualización / Rotationplasty in a schoolboy for osteosarcoma: Prosthesis fitting and update

Introducción La cirugía ablativa era la opción clásica para el tratamiento del osteosarcoma.Tras la aparición de la quimioterapia adyuvante aumenta la supervivencia de estos pacientes, y con ello los niños afectos en edad escolar con alto potencial de crecimiento. Se proponen cirugías reconstructivas con mayor preservación del miembro y mejor función que las amputaciones convencionales. Presentación del caso Describimos un caso de osteosarcoma en un niño de 9 años con antecedente de retinoblastoma. El tumor involucraba toda la longitud del fémur izquierdo. También presentaba una metástasis pulmonar. Ante la respuesta incompleta a la quimioterapia neoadyuvante, se optó por resección ósea abarcando la lesión, rotacionoplastia y protetización del miembro inferior izquierdo y toracoscopia para tratar la lesión pulmonar. Se inició proceso con una ortoprótesis bypass las 6 primeras semanas, hasta comprobar cicatrización, consolidación ósea y ausencia de complicaciones, y una ortoprótesis definitiva los siguientes 4 meses. Al cabo de un año el paciente realizaba marcha independiente con el uso de la ortoprótesis, natación con aleta adaptada al muñón y reiniciaba actividad en bicicleta. En la última revisión clínica, con 13 años, se encuentra libre de enfermedad y sigue controles periódicos en nuestra consulta para adaptaciones oportunas de ortoprótesis acorde a su crecimiento. Discusión Este caso destaca las diversas opciones reconstructivas y las dificultades encontradas en el manejo de estos procesos malignos tan agresivos. La cirugía de rotacionoplastia es una opción terapéutica viable en pacientes jóvenes con osteosarcoma, que permite al niño volver a participar en las actividades de la vida diaria y recreativa premórbidas (AU)

Introduction The classical treatment of osteosarcoma used to be ablative surgery. After the appearance of adjuvant chemotherapy, survival in these patients increased, and with it, the number of affected school age children with high growth potential. Hence, reconstructive surgeries are currently proposed instead of conventional bone resections due to greater limb preservation and better functional status than those achieved with conventional amputations. Case presentation We describe a case of osteosarcoma in a 9-year-old boy with a history of retinoblastoma. The tumour involved the entire length of the left femur. He also had a lung metastasis. Given the incomplete response to neoadjuvant chemotherapy, we chose bone resection, rotation and fitting of the left lower limb and thoracoscopy to treat the lung injury. A bypass ortoprosthesis was placed for the first 6 weeks, until there was healing, bone consolidation and absence of complications, followed by a definitive orthoprosthesis for the next 4 months. At one year, the patient was able to walk independently with the use of the ortoprosthesis, swimming with a fin adapted to the stump and was had restarted cycling. At the last clinical review, at the age of 13 years, he is disease free and continues to have periodic follow-up visits in our office for adaptations to the prosthesis according to his growth. Discussion This case highlights the various reconstructive options available and the difficulties encountered in the management of these aggressive malignant processes. Rotationplasty is a viable therapeutic option in young patients with osteosarcoma, which allows the child to participate again in premorbid daily and recreational activities (AU)

[Aneurysmal bone cyst in the sacrum: Case report and literature review]. / Quiste óseo aneurismático en el sacro: caso clínico y revisión de la literatura.

Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results.

[Rotationplasty in a schoolboy for osteosarcoma: Prosthesis fitting and update]. / Plastia de rotación en escolar por osteosarcoma: Protetización y actualización.

INTRODUCTION: The classical treatment of osteosarcoma used to be ablative surgery. After the appearance of adjuvant chemotherapy, survival in these patients increased, and with it, the number of affected school age children with high growth potential. Hence, reconstructive surgeries are currently proposed instead of conventional bone resections due to greater limb preservation and better functional status than those achieved with conventional amputations. CASE PRESENTATION: We describe a case of osteosarcoma in a 9-year-old boy with a history of retinoblastoma. The tumour involved the entire length of the left femur. He also had a lung metastasis. Given the incomplete response to neoadjuvant chemotherapy, we chose bone resection, rotation and fitting of the left lower limb and thoracoscopy to treat the lung injury. A bypass ortoprosthesis was placed for the first 6 weeks, until there was healing, bone consolidation and absence of complications, followed by a definitive orthoprosthesis for the next 4 months. At one year, the patient was able to walk independently with the use of the ortoprosthesis, swimming with a fin adapted to the stump and was had restarted cycling. At the last clinical review, at the age of 13 years, he is disease free and continues to have periodic follow-up visits in our office for adaptations to the prosthesis according to his growth. DISCUSSION: This case highlights the various reconstructive options available and the difficulties encountered in the management of these aggressive malignant processes. Rotationplasty is a viable therapeutic option in young patients with osteosarcoma, which allows the child to participate again in premorbid daily and recreational activities.

Déficit motor en el puerperio. ¿Es la analgesia neuroaxial la causa más frecuente? / Motor deficit in the puerperium. Is neuroaxial analgesia the most frequent cause?

Los déficits motores de miembros inferiores durante el embarazo y el puerperio son relativamente frecuentes. Se atribuyen habitualmente a complicaciones asociadas a las técnicas neuroaxiales que son realizadas por el anestesiólogo. Pero existen otras posibles causas, como la osteoporosis transitoria de caderas. La osteoporosis transitoria del embarazo es una patología infrecuente y autolimitada de origen desconocido. La complicación más severa que puede presentar son las fracturas patológicas, fundamentalmente en las articulaciones de carga. Esta patología suele presentarse en el tercer trimestre del embarazo y cursa con dolor e impotencia funcional del miembro inferior afecto. Presentamos el caso de una mujer de 35 años, gestante de 40+3 semanas que inicia trabajo de parto. Se coloca catéter epidural normofuncionante y finalmente se decide cesárea por parto estacionado; 48h después comienza con impotencia funcional en miembro inferior izquierdo y dolor. Se realiza RM donde se descarta hematoma epidural y se objetiva osteopenia de caderas, siendo diagnosticada de osteoporosis transitoria el embarazo

Motor deficits of lower limbs during pregnancy and the puerperium are relatively frequent. They are usually attributed to complications which are associated with neuroaxial techniques performed by the anesthesiologist. But there are other possible causes, such as transient osteoporosis of the hips. Transient osteoporosis of pregnancy is a rare and self-limited pathology of unknown etiology. The most severe complication that can occur are pathological fractures, mainly in the load joints. This pathology usually occurs in the third trimester of pregnancy and is showed up with pain and functional impotence of the lower limb affected. We present the case of a 35-year-old woman, 40+3 weeks of pregnancy who starts labour. Normally functioning epidural catheter is placed and finally cesarean section is decided because failure to progress; 48h later the patient begins with functional impotence and pain in the lower left limb. MRI is performed, epidural hematoma is ruled out and osteopenia of the hips is proved. The patient is diagnosed with transient osteoporosis of pregnancy

Osteonecrosis multifocal. Actualización y caso clínico / Multiple osteonecrosis. Update and case report

La osteonecrosis múltiple se define como la presencia de osteonecrosis en 3 o más territorios óseos. Es una complicación infrecuente, que suele encontrarse solo en un 3% de los pacientes con osteonecrosis. Se ha relacionado con enfermedades sistémicas siendo los pacientes con LES, tratamiento prolongado con glucocorticoides a dosis altas, trasplantados o con alteraciones hematológicas los que presentan mayor riesgo de desarrollarla. La cabeza femoral es la zona que en más ocasiones se ve alterada. La patogenia no está bien establecida, aunque se conocen varios factores de riesgo. Presentamos el caso de una mujer joven, con antecedentes de tratamiento con glucocorticoides y anticonceptivos orales, y factores alterados de la hemostasia, que desarrolló una osteonecrosis bilateral de caderas y posteriormente de hombro. En el presente artículo se ha realizado una exhaustiva búsqueda bibliográfica sobre la etiología y tratamiento de la osteonecrosis avascular múltiple

Multifocal osteonecrosis is defined as the presence of osteonecrosis in three or more osseous sites. It is an infrequent entity representing less than 3% of cases among osteonecrosis patients. Multifocal osteonecrosis has been associated with systemic diseases, with patients at highest risk being those with lupus erythematosus, transplant recipients and those with haematological disorders or prolonged high-dose glucocorticoid treatment. The area most prone to disturbances is the femoral head. The pathogenesis of this particular disorder has not been fully defined, although several risk factors have been identified. We report the case of a young woman with abnormal hemostatic factors and a history of glucocorticoid and oral contraceptive therapy who developed bilateral hip osteonecrosis, followed by shoulder ON. The present article also provides an extensive literature review of the aetiology and treatment of multifocal ON

[Multiple osteonecrosis. Update and case report]. / Osteonecrosis multifocal. Actualización y caso clínico.

Multifocal osteonecrosis is defined as the presence of osteonecrosis in three or more osseous sites. It is an infrequent entity representing less than 3% of cases among osteonecrosis patients. Multifocal osteonecrosis has been associated with systemic diseases, with patients at highest risk being those with lupus erythematosus, transplant recipients and those with haematological disorders or prolonged high-dose glucocorticoid treatment. The area most prone to disturbances is the femoral head. The pathogenesis of this particular disorder has not been fully defined, although several risk factors have been identified. We report the case of a young woman with abnormal hemostatic factors and a history of glucocorticoid and oral contraceptive therapy who developed bilateral hip osteonecrosis, followed by shoulder ON. The present article also provides an extensive literature review of the aetiology and treatment of multifocal ON.

Motor deficit in the puerperium. Is neuroaxial analgesia the most frequent cause? / Déficit motor en el puerperio. ¿Es la analgesia neuroaxial la causa más frecuente?

Motor deficits of lower limbs during pregnancy and the puerperium are relatively frequent. They are usually attributed to complications which are associated with neuroaxial techniques performed by the anesthesiologist. But there are other possible causes, such as transient osteoporosis of the hips. Transient osteoporosis of pregnancy is a rare and self-limited pathology of unknown etiology. The most severe complication that can occur are pathological fractures, mainly in the load joints. This pathology usually occurs in the third trimester of pregnancy and is showed up with pain and functional impotence of the lower limb affected. We present the case of a 35-year-old woman, 40+3 weeks of pregnancy who starts labour. Normally functioning epidural catheter is placed and finally cesarean section is decided because failure to progress; 48h later the patient begins with functional impotence and pain in the lower left limb. MRI is performed, epidural hematoma is ruled out and osteopenia of the hips is proved. The patient is diagnosed with transient osteoporosis of pregnancy.

Hombro doloroso: hemangioma en el músculo subescapular / Painful shoulder: hemangioma of the subscapularis muscle

Presentamos una tumoración vascular benigna, un hemangioma, situado en el músculo subescapular como causa de hombro doloroso en una mujer joven, caso poco frecuente en la literatura. Mujer de 30 años remitida a nuestra consulta por omalgia izquierda de 3 años de evolución, con radiografía y resonancia magnética cervical y de hombro izquierdo sin hallazgos significativos. Presenta dolor en la región escapular medial izquierda sin masa palpable. La resonancia magnética de la escápula informa de una tumoración vascular intramuscular, ovalada, bien definida, compatible con hemangioma subescapular. Tras la exéresis de la tumoración y el tratamiento rehabilitador posterior la paciente se encuentra asintomática. Los hemagiomas son tumores vasculares benignos que pueden manifestarse con dolor tras una actividad prolongada por la derivación del flujo sanguíneo que se produce desde el tejido circundante al hemangioma. Suelen tener buen pronóstico (AU)

We present a case of a benign vascular tumour, a haemangioma located in the subscapularis muscle as a cause of painful shoulder in a young woman. Such cases have rarely been reported in the literature. A 30-year-old woman was referred to our clinic for a 3-year history of shoulder pain and no significant findings on X-ray and magnetic resonance imaging of the cervical spine and left shoulder. The patient had pain in the left medial scapular area with no palpable mass. Magnetic resonance imaging of the scapula revealed an oval, well-defined, intramuscular vascular tumour compatible with haemangioma of the subscapularis muscle. After excision of the tumour and subsequent rehabilitation treatment, the patient is asymptomatic. Haemangiomas are benign vascular tumours that can cause pain due to swelling in the area of the tumour after prolonged activity. Prognosis is generally favourable (AU)

Amastia y atelia como manifestación excepcional de la displasia ectodérmica hipohidrótica en una mujer adolescente / Amastia and athelia as an exceptional presentation of hypohydroticectodermal dysplasia in an adolescent female

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